| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $137 | $150 | $163 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $62 | $64 | $66 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $92 | $93 | $94 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $92 | $125 | $157 |
| Group psychotherapy CPT 90853 • Mental Health | $44 | $46 | $47 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $30 | $30 | $30 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $66 | $66 | $66 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $16 | $16 | $16 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $62 | $206 | $351 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $56 | $56 | $56 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $22 | $22 | $22 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $161 | $161 | $161 |
| EMG needle each extremity complete CPT 95886 • Neurology | $37 | $67 | $97 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $18 | $53 | $89 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $65 | $65 | $65 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $47 | $47 | $47 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $88 | $131 | $175 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $143 | $143 | $143 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $44 | $68 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $76 | $102 | $129 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $24 | $77 | $129 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $30 | $138 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $11 | $21 | $30 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $30 | $42 | $54 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $93 | $102 | $110 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $77 | $118 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $147 | $160 | $173 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $10 | $90 | $170 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $13 | $72 | $131 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $193 | $195 | $198 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $80 | $129 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $7 | $68 | $129 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $97 | $113 | $129 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $8 | $69 | $129 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $102 | $115 | $129 |
| Consultation office low complexity CPT 99243 • Office Visits | $58 | $102 | $145 |
| Consultation office high complexity CPT 99245 • Office Visits | $254 | $254 | $255 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $30 | $226 | $421 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $8 | $19 | $30 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $1,131 | $1,131 | $1,131 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $148 | $148 | $148 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $30 | $94 | $157 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $483 | $483 | $483 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $159 | $159 | $159 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $536 | $536 | $536 |
| Cataract surgery with intraocular lens insertion CPT 66984 • Ophthalmology | $78 | $78 | $78 |
| Intravitreal injection therapeutic agent CPT 67028 • Ophthalmology | $109 | $109 | $109 |
| Retinal detachment repair with vitrectomy CPT 67108 • Ophthalmology | $1,141 | $1,141 | $1,142 |
| Retinal photocoagulation treatment CPT 67210 • Ophthalmology | $30 | $67 | $105 |